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ALF Monitoring at Transplant Centre — RACP Adult Medicine MCQ

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ModerateGastroenterologyALF Monitoring at Transplant CentreRACP Adult Medicine

A 30-year-old woman with seronegative ALF (all hepatitis serologies negative, autoimmune markers negative, drug screen negative, Wilson markers normal) has Grade II encephalopathy and INR 3.5. Liver biopsy shows massive hepatic necrosis. She does NOT meet King's College Criteria yet. What is the most appropriate monitoring approach?

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Correct answer: B — ICU with 4-hourly King's College Criteria assessment

ALF with progressive encephalopathy approaching King's College Criteria requires ICU admission at a transplant centre with serial assessment of KCC components (pH, INR, creatinine, encephalopathy grade) every 4-6 hours. Rapid deterioration can occur. Early transfer to a transplant centre is essential — do not wait until KCC are met (may be too sick to transfer). Prognostic models (MELD, KCC, Clichy criteria) guide transplant listing decisions.

Reference: EASL – 2024 – ALF; eTG GI 2024